Provider Demographics
NPI:1093123861
Name:MONTENEGRO, GIANNY (DDS)
Entity Type:Individual
Prefix:DR
First Name:GIANNY
Middle Name:
Last Name:MONTENEGRO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19161 NW 78TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-5263
Mailing Address - Country:US
Mailing Address - Phone:305-926-5764
Mailing Address - Fax:
Practice Address - Street 1:6741 SW 24TH ST STE 14
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1765
Practice Address - Country:US
Practice Address - Phone:305-264-0595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 20788122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist